Policy & Compliance

  • April 15, 2025

    Medicare Advantage 'Upcoding' In Federal Crosshairs

    Dr. Mehmet Oz and others have called for a crackdown on fraud and waste in privately run Medicare plans. But addressing "upcoding" won't be easy, and healthcare attorneys are watching to see whether the increased attention translates into actual enforcement.

  • April 15, 2025

    Abortion Bans At Wyo. High Court: 3 Things To Know

    Wyoming’s highest court is set to hear arguments over whether two near-total abortion bans violate the state Constitution and its guarantee of personal choice in healthcare.

  • April 14, 2025

    9th Circ. Says $24M Punitive Damages In Jail Death Too Steep

    A jury correctly determined that a healthcare contractor was liable for the death of a woman in custody in a Washington jail, a split Ninth Circuit panel ruled Monday, but its $24 million award for punitive damages was excessive.

  • April 14, 2025

    Ark. PBM Regulation Violates ERISA, Teamsters Fund Says

    An Arkansas insurance regulation forcing health plans to turn over information about reimbursement rates negotiated by pharmacy benefit managers, or PBMs, conflicts with federal benefits law, a Teamsters healthcare fund claimed, urging an Illinois federal court to block the state from enforcing the rule.

  • April 14, 2025

    Judge Threatens Penalties Over Late Report In Fla. Fee Suit

    A Florida federal judge threatened parties in a federal proposed class action over excessive fees charged to maintain retirement savings plans, warning there will be sanctions if they do not respond to an order to show why they failed to timely file a case management report.

  • April 14, 2025

    Quinn Emanuel, King & Spalding Rep Harvard In Trump Letter

    Harvard University on Monday turned to a pair of high-powered lawyers from Quinn Emanuel Urquhart & Sullivan LLP and King & Spalding LLP as the school pushed back on the Trump administration's policy demands linked to nearly $9 billion in federal funding — a move that prompted the government to freeze more than $2 billion in grants for the school.

  • April 14, 2025

    FTC Joins DOJ In Targeting Anticompetitive Regulations

    The Federal Trade Commission launched a public inquiry Monday to look into reducing regulations that are hindering competition, following a similar move by the U.S. Department of Justice last month.

  • April 14, 2025

    Takeda Gets Actos Case Paused For Class Cert. Review

    A New York federal court has paused a lawsuit accusing Takeda Pharmaceuticals of inflating the price of its diabetes treatment, Actos, by delaying the entry of generic alternatives, and took a scheduled July trial off the calendar, as the company appeals a class certification ruling.

  • April 14, 2025

    Healthcare Duo Joins Carlton Fields From Mass. Boutique

    Carlton Fields announced Monday that a pair of experienced healthcare attorneys joined the firm's Los Angeles and Tampa, Florida, offices after a stint with Massachusetts boutique Kajko Weisman & Colasanti LLP.

  • April 14, 2025

    Sandoz Sues Amgen Over Enbrel Biosimilar

    Sandoz accused Amgen of illegally blocking biosimilar competition to its blockbuster Enbrel drug for arthritis and other inflammatory diseases, alleging that the company used strategic acquisitions and illegal patent extensions to fend off challengers in the space and inflate U.S. prices for its drug.

  • April 11, 2025

    Amgen Can't Ditch Regeneron's Bundling Antitrust Suit

    A Delaware federal judge on Thursday denied Amgen's bid to toss antitrust litigation brought by Regeneron accusing its rival of using a bundling scheme to increase the sales of its cholesterol drug Repatha and push competitors out of the market.

  • April 11, 2025

    Express Scripts Judge Asks If Khan's FTC Exit Affects Suit

    The Missouri federal judge overseeing Express Scripts' lawsuit accusing the Federal Trade Commission of defaming it with a report excoriating the pharmacy benefits manager for allegedly inflating drug costs asked the parties Friday if new leadership at the commission affects the case that significantly targets former Chair Lina Khan.

  • April 11, 2025

    Telehealth Co. Sued Over 2024 Data Breach

    A company that helps healthcare providers manage after-hours patient calls was hit with a proposed class action in New York federal court Friday alleging that it failed to secure user data prior to a 2024 breach that exposed the sensitive information of nearly 1 million people.

  • April 11, 2025

    Fla. Pharmacy Pleads Guilty To Fraud Over Opioid OD Drug

    A Florida-based pharmacy has agreed to plead guilty to healthcare fraud and to pay more than $1 million to settle civil claims it submitted false authorizations for an expensive opioid overdose treatment to federal insurers.

  • April 10, 2025

    AbbVie Wants ND, SD Drug Pricing Laws Blocked

    Drugmaker AbbVie Inc. on Thursday asked federal courts to block new drug-pricing laws in both North Dakota and South Dakota, alleging that the measures requiring the company to transfer products to certain pharmacies at discounted prices are unconstitutional.

  • April 10, 2025

    Vanda Sues FDA To Block Off-Label Use Drug Promo Regs

    A pharmaceutical company, a Texas physician and an often-jet lagged traveler sued the U.S. Food and Drug Administration in Texas federal court Wednesday seeking to block marketing restrictions on the off-label uses of FDA-approved drugs, arguing that long-standing rules and Biden-era guidance runs afoul of the First Amendment.

  • April 10, 2025

    Calif. Centers Used 'Body Brokers' In $10M Scam, BCBS Says

    Blue Cross Blue Shield of Oklahoma slammed two California recovery centers and their owners with a lawsuit Thursday, alleging they spearheaded a $10 million kickback scheme to employ "body brokers" to find Indigenous patients for substance treatment facilities where they went to appalling lengths to stop them from leaving.

  • April 10, 2025

    Holmes Seeks Full 9th Circ. Review Of Theranos Fraud Appeal

    Convicted Theranos Inc. founder Elizabeth Holmes has asked the Ninth Circuit for en banc review of a panel's decision to affirm her criminal fraud conviction and 11-year prison sentence, saying problems with the opinion included a "time-warping relevance theory."

  • April 10, 2025

    Man Admits To $12.5M PPE Investment Fraud

    A California man pled guilty Thursday to defrauding investors of $12.5 million by telling them he had a business opportunity to manufacture personal protective equipment and to create an aerosol product that would kill the coronavirus, Texas federal prosecutors said.

  • April 10, 2025

    Mich. Justices Mull Hospital's Liability For Contract Doc's Acts

    The Michigan Supreme Court on Thursday weighed a Corewell Health hospital's possible vicarious liability for independent physicians practicing within the hospital, with one justice pushing back on the idea that liability would be limited to emergency rooms.

  • April 09, 2025

    Mass. Justices Asked To Raise Bar For Pension, Benefit Loss

    Massachusetts' highest court was asked on Wednesday to adopt a more expansive interpretation of what constitutes cruel or unusual punishment or an excessive fine in the case of a former state trooper whose $1 million public pension and healthcare benefits were forfeited after his conviction in an overtime fraud case.

  • April 09, 2025

    2nd Circ. Allows Takeda To Appeal Actos Antitrust Class Cert.

    A split Second Circuit will allow Takeda Pharmaceuticals Co. to immediately appeal a New York federal judge's ruling certifying two classes of direct purchasers and end payors in consolidated antitrust actions accusing the company of unlawfully inflating the price of its diabetes treatment Actos by delaying the entry of generic alternatives.

  • April 09, 2025

    Fertility Care Concerns Linger As PWFA Regs Face Revision

    Efforts to pare down the U.S. Equal Employment Opportunity Commission's regulations requiring workplace accommodations for pregnancy-related conditions have centered largely on abortion, but experts warn that access to fertility treatment — which workers seek more frequently — may also become harder to get.

  • April 09, 2025

    Data Co. Can't Make DOL Accept Health Plan, Judge Says

    A data-mining company can't force the U.S. Department of Labor to acknowledge that a health insurance plan offered in exchange for participants' user data is covered by federal benefits law, a Texas federal judge ruled, saying the case's thin record prevented the court from deciding issues the Fifth Circuit told it to consider.

  • April 09, 2025

    Religious Mission Justifies Philly Injection Site, 3rd Circ. Told

    Counsel for a nonprofit seeking to open a safe injection site in Philadelphia told the Third Circuit Wednesday that it qualified as a religious organization immune from prosecution, despite not having any spiritual language in its incorporation documents.

Expert Analysis

  • Dispelling 10 Myths About Health Provider-Based Compliance

    Author Photo

    Congress appears intent on requiring hospitals to submit provider-based attestations for all off-campus outpatient hospital locations, so now is the time for hospitals to prepare for this change by understanding common misconceptions about provider-based status and proactively correct noncompliance, say attorneys at McDermott.

  • A Look At HHS' New Opinion On Patient Assistance Programs

    Author Photo

    A recent advisory opinion from the U.S. Department of Health and Human Services' Office of Inspector General follows a recent trend of blessing patient assistance program arrangements that implicate the Anti-Kickback Statute, as long as they are structured with appropriate safeguards to minimize the risk of fraud and abuse, say attorneys at Sheppard Mullin.

  • 2 Anti-Kickback Developments Hold Lessons For Biopharma

    Author Photo

    The U.S. Department of Justice's Anti-Kickback Statute settlement with QOL Medical and a favorable advisory opinion from the U.S. Department of Health and Human Services provide a study in contrasts, but there are tips for biopharma manufacturers trying to navigate the vast compliance space between them, says Mary Kohler at Kohler Health Law.

  • Tips For Pharma-Biotech Overlap Reporting In New HSR Form

    Author Photo

    While there’s no secret recipe for reporting overlaps to the Federal Trade Commission in the new Hart-Scott-Rodino Act form, there are several layers of considerations for all pharma-biotech companies and counsel to reflect on internally before reporting on any deal, say attorneys at A&O Shearman.

  • A Look At Drug Price Negotiation Program's Ongoing Impact

    Author Photo

    More than two years after the passage of the Inflation Reduction Act and the rapid implementation of the drug price negotiation program, attorneys at Ropes & Gray discuss how the IRA has influenced licensing strategies, and how maximum fair prices under the law have economically affected certain drugs.

  • Preparing For A Possible End To The Subminimum Wage

    Author Photo

    The U.S. Department of Labor's proposed rule to end the subminimum wage for employees with disabilities may significantly affect the community-based rehabilitation and training programs that employ these workers, so certified programs should be especially vigilant about compliance during this period of evaluation and scrutiny, say attorneys at Jackson Lewis.

  • Drug Pricing Policy Trends To Expect In 2025 And Beyond

    Author Photo

    Though 2025 may bring more of the same in the realm of drug pricing policy, business as usual entails a sustained, high level of legal and policy developments across at least six major areas, say attorneys at Ropes & Gray.

  • Top 10 Healthcare And Life Sciences Issues To Watch In 2025

    Author Photo

    Under the new Trump administration, this coming year may benefit some healthcare and life sciences stakeholders, while creating new challenges for others amid an increasingly complex regulatory environment, say attorneys at Debevoise.

  • 4 Keys To Litigating In An Active Regulatory Environment

    Author Photo

    For companies facing litigation influenced by government regulatory action — a recent trend that a politically charged atmosphere will exacerbate — there are a few principles that can help to align litigation strategy with broader public positioning in the regulatory and oversight context, say attorneys at Jenner & Block.

  • How Views On Healthcare Price Transparency Are Changing

    Author Photo

    Regulators' attitudes toward price transparency regulation have shifted over the past several years in ways that may seem contradictory, and research into detailed rate information published by hospitals and health plans has yielded mixed results, says Matthew List at Charles River Associates.

  • EEOC Wearable Tech Guidance Highlights Monitoring Scrutiny

    Author Photo

    The U.S. Equal Employment Opportunity Commission's recent fact sheet on wearable technologies cautions against potential issues with federal anti-discrimination laws and demonstrates growing concern from regulators and legislators about intrusive technologies in the workplace, say attorneys at Littler.

  • Navigating The Potential End Of GLP-1 Drug Shortages

    Author Photo

    The U.S. Food and Drug Administration's determination of whether GLP-1 products are in shortage may affect how compounders provide these products and spur a range of litigation including patent disputes and unfair competition suits, say attorneys at Goodwin.

  • Politicized OIGs Could Target Federal Employees, Contractors

    Author Photo

    After President Donald Trump fired nearly 20 inspectors general last week, it’s worth exploring how the administration could use Offices of Inspectors General to target federal employees and contractors, why it would be difficult to fight this effort, and one possible bulwark against the politicization of these watchdogs, says Sara Kropf at Kropf Moseley.